Scheduled bowel management system

ABSTRACT

A system for scheduling and controlling the maintenance and functioning of the large bowel in fecally incontinent patients is provided which comprises inducement of a multi-day period of constipation followed by administration of colon sweeping procedure which completely empties the contents of the entire colon. The scheduled complete emptying of the colon using the technique of the present invention will greatly reduce the time, effort and cost involved in the care and treatment of fecally incontinent patients, reduce the risk of infection, and maximize the safety, health, comfort and sanitation of the patient and his environment. An apparatus is also provided in the invention which is tailored to be used in the present system, and which will allow for a complete emptying of the entire colon in a safer, more comfortable, and more effective manner than previously possible.

This is a continuation of application Ser. No. 07/555,033 filed Jul. 20,1990, now U.S. Pat. No. 5,074,842, granted Dec. 14, 198 .

FIELD OF THE INVENTION

This invention relates to a method and apparatus for controlling andscheduling the functions of the human colon in order to prevent oreliminate fecal incontinence.

BACKGROUND OF THE INVENTION

Fecal continence is the ability to defer defecation until an appropriatetime at an appropriate place. Fecal incontinence is the inability todefer defecation, commonly present in the elderly, spinal cord or headinjury patients and other disabled persons, and in persons having othergeneralized diseases or abnormalities of the rectum or perineum. For athorough summary of diagnoses of fecal incontinence by type of diseaseand area of dysfunction, see Schiller, "Fecal Incontinence" inGastrointestinal Disease, (Fourth Ed., 1989), pg. 323.

There are many degrees of fecal incontinence, from complete lack ofcontrol of defecation, even with solid stool, to continuous dribbling ofliquid stool in persistent and long standing diarrhea, to evenoccasional, intermittent slight soiling of clothing associated withacute attacks of diarrhea. At present, management of complete fecalincontinence consists principally of keeping the patient in diapers. Thepassage of stool is identified by the patient, if mentally competentenough to recognize it, who then informs an attendant. Otherwise, theodor of the stool in the vicinity of the patient or the regular visualcheck of the diaper are the usual means of learning that stool has beenpassed by the patient.

This practice, however, is extremely troublesome and unhealthy becauseeven though solid or semi-formed stool can be captured fairlyeffectively by a diaper, stool frequently is squashed forward andbackward between the buttocks and then onto and around the externalgenitalia and down the legs of the patient. Diarrheal (liquid) stool mayleak or flow outside the diaper and onto the bed, and up the back of thepatient and down along the legs. An even further problem is presentedwhen a patient is seriously impaired mentally, in that he or she mayreach down inside the diaper, grasp the stool, and smear it onto therest of the body, including regions such as face and hair, or onto thebed before such practice is discovered.

It is clear that problems associated with the diaper system of managingfecally incontinent patients are substantial in a number of ways. Forinstance, the clean-up alone associated with such incidents requires acomplete bath for the patient, a complete change of bed linens andclothing, and a complete cleaning of the bed frame which may becontaminated with stool not readily visible. Further, the inevitablespread of fecal contamination by a diaper may cause infection of theskin of the perineum, external genitalia, buttocks, legs, arms, head andlower trunk of the patient, and may contribute to the creation andpersistence of decubitus ulcers or bed or pressure sores. Extensivebathing and re-bathing of the patient, changes of bed linen and thepatient's clothing, and procedures necessary to combat the spread ofinfection are all extremely expensive both in terms of health careworker's time and hospital supplies.

The problem of incontinence is one that has far reaching effects onsociety in general as well. Fecal incontinence is often the major factorin the decision to institutionalize an elderly or otherwise impairedfamily member. Often, these patients require two to three times theamount of nursing care that similar but continent patients need. It isestimated that the care of institutionalized incontinent patients in theUnited States alone costs approximately eight billion dollars per year.In England, the prevalence of fecal incontinence in the generalpopulation has been estimated to be as high as 0.4 percent in general,and between 1.0 and 1.3 percent in the elderly population (i.e., thoseover 65 years old). In other studies, as many as fifty percent ofinstitutionalized patients were observed to have fecal incontinence.Clearly, the problem of institutionalizing incontinent family memberswill be alleviated if a method were found that could allow theincontinent patient to be treated simply and effectively at home.

The one major method most commonly used at present in dealing with thisproblem, the diapering of patients, is not really treatment, but is anattempt to minimize the problem by capturing the stool when it isexpelled from the rectum. As indicated above, this method is totallyunsatisfactory. However, other methods used presently to treatincontinence have not been satisfactory either.

One non-specific strategy that has been used comprises keeping the colonand the rectum empty of feces by stimulating defecation at regularintervals by use of enemas and/or digital stimulation of the anus andrectum. Unfortunately, present nursing and medical practice texts listonly small volume enemas, commonly administered in the left lateraldecubitus position. As a result, this procedure will clean only therectum, sigmoid, and a portion of the descending colon, as has beenpointed out in my previous patent, U.S. Pat. No. 4,403,982, incorporatedherein by reference.

The stimulation of defecation at regular intervals using conventionalenema procedures does not cleanse the entire colon at all. After aroutine less-than-a-liter enema administered with the patient lying inthe left side-down decubitus position, residual stool is often stillpresent in the cecum, ascending colon, transverse colon and descendingcolon even after defecation following this type of enema. This prior artmethod thus does not completely empty the entire colon of feces, gas andliquids. As a result, residual matter can remain in the cecum, orascending or transverse segments of the colon, which then moves distallyand can be expelled at any place and time by the incontinent patient.

Still another alternative treatment currently in use is theadministration of anti-diarrheal drugs and a low residue bland dietwhich are used to arrest diarrhea. Although these methods are useful inreducing the expulsion of liquid stool from the colon, they present aserious risk of causing the development of fecal impactions in thecolon, which if located too high can only be reached with a flexiblecolonoscope. Flexible colonoscopy requires sedation or anesthesia, andthese procedures carry their own further risks. Additionally, diagnosisof high impactions, located proximal to the rectum, if often difficult,and may result in dangerous impactions not being diagnosed promptly.Thus anti-diarrheal drug treatment alone, at present, is unsatisfactoryas a method of controlling the problem of fecal incontinence.

It is clear that the conventional methods most commonly used at presenthave failed to provide a safe, effective, inexpensive and sanitarymethod for dealing with the widespread problem of fecal incontinencewhich affects patients having a variety of conditions. It is thus highlydesirable to develop a system for managing fecally incontinent patientswhich can be effective in reducing the many medical and economicproblems associated with this condition. Additionally, it is desirableto have a system which will have low risk of harmful side effects, whichwill afford significant therapeutic benefits to the patient and tosociety, and which will allow for safer, more effective, and lessexpensive management of the functions of the colon in a great number ofafflicted patients.

SUMMARY OF THE INVENTION

According to the present invention, a system for managing fecallyincontinent patients in a safe, effective, and inexpensive manner isprovided which comprises the scheduling of the function of the bowelthrough inducement of constipation for a multi-day period, followed byscheduled administration of a colon sweeping procedure employing anapparatus provided by the present invention in a manner so as tocompletely empty the entire colon of feces, gas and liquids, andvirtually eliminate fecal incontinence episodes between scheduled colonsweepings. The complete emptying of the colon will preferably occur atscheduled intervals such as every three or four days. The schedulingtechnique of the invention will greatly reduce the amount of time andeffort that health care personnel will need to spend on incontinentpatients, will lower the risk of infection to the patient treated, andwill improve the overall sanitation of the health care environment.

In another aspect of the present invention, an apparatus is providedthat comprises an improved device for administering a colon sweepingprocedure which causes complete emptying of the entire colon, and whichhas particularly been designed for maximizing safety, effectiveness andcomfort to the patient of the procedure of the invention. The device ofthe present invention comprises a liquid container having apredetermined quantity of fluid sufficient to substantially fill apatient's entire large intestine and an improved tube for introducingthe liquid into the patient. The device of the invention also has a softor "floppy" tip which will easily bend back upon itself if it encountersa mucosal fold in the rectum or if it enters a diverticulum. This"floppy" tip will thus virtually eliminate the risk that the tubeemployed might perforate the colon mucosa or a diverticulum.

In still another aspect of the present invention, the device provided isdesigned with instructions so that the rate of flow of liquid into thepatient is positively and strictly limited so as to not exceed more than100 ml per minute, or about 20 minutes for 2,000 ml of isotonic fluid.This feature further maximizes the benefits of the present invention inthat the more slowly fluid is infused to distend the colon, the safer,more comfortable, and more effective the present procedure will be.

A further improvement of the present device is that the tube employed tochannel fluid into the patient is an integral double-lumen tube havingone channel for the sweeping solution and a second channel for injectingand removing air from a specially-shaped balloon which is used to retainthe tube in place. This double-channeled tube is an improvement overprior systems which have used completely separate tubes to channel fluidand to inflate the balloon. The feature found in the present inventioninsures that twisting, kinking or other occlusion of the rubber tubeleading to the balloon will not be possible. Thus, occasional difficultyin filling or deflating the balloon will be virtually eliminated.

The scheduling technique and system as provided in the present inventioncan thus be used effectively to eliminate problems associated with fecalincontinence, and at the same time provide for scheduled therapeuticcleansing of the entire colon in a manner which affords maximum safetyand comfort to the patient. Other features and advantages of the presentinvention will be further described in or inherently obvious from thedetailed description provided below.

It should also be noted that the method and apparatus of the presentinvention can be used beneficially by a person who has had a colostomy,for whom the colon elimination orifice is an opening made through theabdominal wall, rather than the anal opening. Normally a bag is attachedto the colostomy opening to collect the fecal matter. However, sincethere is no mechanism associated with this opening (such as the analsphincter muscles of the rectum and anus) to control the movement offecal matter out of this orifice, the present invention would be verybeneficial for such persons in lieu of or in addition to a bag. Whenusing the present method on such persons, the liquid would of course beadministered through the colostomy opening. As in the case of analadministration of the liquid, a balloon or other means would be employedto positively assure retention of the liquid within the colon.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic view illustrating certain elements of the presentinvention.

FIG. 2 is an enlarged axial cross-sectional view of the end of the tubeshown in FIG. 1.

FIG. 3 is a cross-sectional view taken along line 3--3 of FIG. 2.

FIG. 4 is a schematic view of the anal opening and the rectum of apatient including the tube of the present invention inserted therein,with a left-hand portion shown in section.

FIG. 5 is a schematic view similar to FIG. 4, but showing the elementsof the present invention in a final operative position.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

In accordance with the present invention, a novel system for preventingfecal incontinence in humans is provided which comprises controlling thefunction of the colon by inducing a state of constipation followed byperiodic complete emptying of the entire colon about every two to fivedays, and preferably about every three to four days, or other suitableperiod of time as determined by the needs of a particular patient. Thissystem represents the first attempt to control and utilize the abilityof the colon to store feces in an effective method for controlling fecalincontinence. The storing of feces in the colon while it awaitsscheduled expulsion is a normal bowel function which allows for maximumabsorption of salts and water. This storing of feces can be promoted ina number of ways, including administration of anti-diarrheal drugs tothe patient, providing the patient with a bland low-residue diet, ormodifying the diet to restrict intake of fluids and certain foods. Thesemeasures can successfully promote retention of stool, particularly inthe ascending and transverse colon.

In prior art methods employing means to retention of feces, the majordrawback was that only ordinary (typically less-than-a-liter) enema wasgiven periodically which did not clean the entire colon. As a result,these previous methods allowed for substantial amounts of fecal matterto remain in the cecum, the ascending and transverse segments of thecolon, and sometimes even in the sigmoid colon. This constituted a majordisadvantage in that these previous methods were not capable ofpreventing patients from expelling fecal matter from the colon duringthe period between enemas, without risk of high fecal impaction.

In the present invention, as will be further described below, fecalmatter is completely swept from the entire colon during the newcleansing procedure, preferably using the method and apparatus of theinvention as will be further described below. As a result, the presenttechnique can be more safely and effectively used to virtually eliminatethe problems presently associated with fecal incontinence in a varietyof patients. It is contemplated that the scheduling system of thepresent invention can be conducted on almost any fecally incontinentpatient so as to maximize safety and minimize effort and expensepresently needed to care for these patients. Further, the system of theinvention also maximizes patient comfort and sanitation of the patient'senvironment while providing therapeutic benefits as well.

In the preferred method of the present system, the entire contents ofthe colon are swept out using a procedure to be discussed herein, andthen a condition of constipation is induced in a fecally incontinentpatient for a period of generally about three to four days, depending onthe specifics of the patient's condition. This induced constipation isthen followed by a complete evacuation of the colon contents using theapparatus and method which will be described herein below. As indicatedabove, constipation can be induced in a number of ways which willusually depend upon the nature of the patient's disorder as well as hisor her age and condition. Preferably, diet modification and theadministration of anti-diarrheal drugs such as the anti-cholinergicdrugs Lomotil and Loperamide (Imodium A-D) Will be used to safely reducecontractions of the colon and effectively induce a condition ofconstipation in accordance with this invention.

While in the condition of impaired motility or constipation, it isapparent that the patient will not soil himself or the bed sheets, andthus overall hygiene of the patient and the general environment will bevastly improved. After a period of usually about three or four days on ascheduled basis, the patient will be given a special colon cleansingprocedure to completely evacuate the large bowel safely and with aminimum of discomfort, as will be discussed further below. Generally,about four hours before sweeping out the contents of the entire colon,the anti-diarrheal drugs will be discontinued. This drug treatment isresumed only after the colon has been swept clean using the method ofthe present invention.

It is clear that the system contemplated by the present invention willgreatly reduce the risks, time, effort and expense involved in patientcare in that scheduled colon sweeping is required only once every fewdays, and accidents between sweepings are virtually eliminated. Thescheduling techniques of the system disclosed herein can be tailored topractically any incontinent patient regardless of condition, but will beparticularly advantageous in the case of elderly patients, patients withdiarrhea and incontinence of various types, and patients with head orspinal cord injuries where normal functioning of the bowel ha beenimpaired. The present invention thus provides a system which not onlyallows removal of the contents of the entire colon in a safe andeffective manner with maximum comfort to the patient, as will be furtherdescribed below, but one which can be employed in order tocomprehensively manage and schedule the functions of the colon to theconvenience of patient, staff or attendants. The present system thusgreatly reduces the time, effort and cost needed in the care of patientswith various colonic disorders, and at the same time provides maximumsafety and therapeutic benefits to incontinent patients as well.

In another aspect of the system of the present invention, an apparatusis provided for safely, comfortably and effectively completely removingthe contents of the entire colon of the patient. The apparatus of theinvention, as observed in FIGS. 1-5, has a number of advantages andimprovements which are not disclosed in devices previously used for sucha purpose.

The device for carrying out the colon sweeping procedure of the presentinvention, as observed in FIG. 1, comprises a liquid container 10,preferably a plastic container, e.g., a plastic bag that has beenprepackaged with a desired quantity of liquid, preferably distilledwater of a controlled mineral content. Additionally, the container caninclude additives in appropriate concentrations such as polyethyleneglycol 3350 (or PEG 3350), a laxative (preferably Bisacodyl), alubricating and wetting agent (such as castile soap or other suitablewetting agent), suitable electrolytes, and salts and colloids to controlosmolality or isotonicity.

Preferably, the fluid used in the present invention will be one which isisotonic and isosmolar with colon mucosa and blood so as to prevent anysignificant alteration of the total water or electrolytes circulating inthe patient's blood. Additionally, this fluid prevents any significantalteration of the concentration of electrolytes in the intercellular orintracellular spaces. An example of a suitable fluid which with addedelectrolytes can be combined with distilled water to give an appropriateisotonic fluid for use in the present system is polyethylene glycol3350, which has been used in the oral lavage method of intestinalcleansing. Products employing polyethylene glycol 3350 include Colyte(Reed & Carnrick, Piscataway, N.J.) and GoLytely (BraintreeLaboratories, Inc., Braintree, Mass.), wherein the PEG 3350 is combinedwith suitable amounts of sodium chloride, potassium chloride, sodiumbicarbonate, sodium sulfate and water before use Colyte and GolLytely donot contain laxatives, but act by fluid volume alone. In the presentinvention, these isotonic lavage solutions are combined with laxativesand are administered anally, unlike previous methods wherein thepolyethylene glycol and other fluids have been administered orally as anintestinal lavage to clear the colon without the addition of a laxative.

It is possible to prepackage the above solid electrolytes in dry formfor use in the present invention as an alternative to prepackaging thedesired quantity of isotonic liquid. In this embodiment, thepre-packaged dry ingredients are preferably sealed in a plasticcontainer or other package which includes printed instructions so thatthe colon sweeping fluid can be reconstituted at point of use with thedesired volume of distilled water.

As can be further observed in FIG. 1, extending down from the container10 is the flow tube 11 onto which is attached a specially-shaped balloon12 designed to retain the tube in the rectum and which can be inflatedafter the tube is inserted. Air to the balloon is delivered through asyringe valve 13 into line 14, which communicates with an air passage20, as best observed in FIGS. 2 and 3. This configuration provides anintegral double-lumen tube having one lumen or channel which allows thecolon sweeping solution to enter the patient, and a second channel whichdelivers or removes air from the balloon 12 used to retain the tube inplace. As a result of this double-channel tube, the present inventionconstitutes an improvement over prior art systems which use separatetubes to the balloon and to the lumen of the colon in that twisting andkinking or other occlusion of the rubber tube leading to the balloonwill be virtually eliminated. The present system thus greatly reducesthe possibility that the tube to the balloon will obstruct, hinderinginjection or removal of air from the balloon.

The air passage 20 is integral with the tube 11 and receives air fromline 14 which is delivered into the balloon 12. The balloon itself ispreferably made of a plastic, flexible and distensible butnon-stretchable material so that its fully expanded shape and size arepositively controlled and determined. When air is removed from theballoon 12, it simply collapses and lies along the side wall of tube 11,as best observed in FIG. 4. As indicated above, the dual-channelednature of tube 11 insures that obstruction to inflation or deflation ofthe balloon will not occur.

With particular reference to FIGS. 2 and 4, the tube 11 of the presentinvention is relatively flexible and thin walled in construction, andhas a "floppy" distal segment or tip 16. It is preferred that the floppysegment of the tube be straight upon entering the colon unless subjectto resistance, such as upon entering a diverticulum or encountering afold of the mucosa or inner lining of the colon. As a result of havingthis "floppy" tip, the tube of the present invention has virtuallyeliminated the risk that it might perforate a diverticulum it may enter.Preferably, the tube will have a wall thickness of roughly 0.5-4.0 mm,and it will preferably be comprised of polyethylene, rubber or othersimilar material. The floppy tip 16 connected to tube 11 will besufficiently "floppy" that although it will stand up or align on itsown, it will also easily bend down along the side of the main tubeunless urged outwardly by the force of the liquid in the tube 11. Thefloppy tip 16 may be integral with the material of the tube 11 and cancomprise a portion thereof which is drawn much thinner. Preferably, tip16 will have a wall thickness of about 0.1-1.0 mm. Alternatively, aseparate flexible material may be adhered to the end of the tube,preferably in such a manner that the exterior surfaces merge smoothlytogether.

The liquid from the container 10, passing through the tube 11, passesout from the tube and into the rectum of the patient through one or moreopenings 15 in tube 11. The openings 15 are preferably designed suchthat under the low pressure head of fluid in the container 10, theypermit only the desired rate of flow of liquid. This feature furtherensures maximum safety and comfort to the patient.

In a typical apparatus to be used in accordance with the presentinvention, it will be desirable to limit the flow of fluid into thepatient to no more than about 100 ml per minute, or a total of about 20minutes for a 2,000 ml total volume colon cleansing procedure. This is arelatively long time for filling of the large intestine, but thisfeature will provide much greater safety and comfort to the patient, andwill reduce the pain which can be caused by too rapid filling of thelarge intestine. The limited flow will also reduce the risk of autonomicdysreflexia, which may occur with upper thoracic levels of spinal cordinterruption or transection. The benefits of the present system aremaximized in that the slow dispensing of fluid into the patient todistend the colon is much safer, more comfortable, and much moreeffective than previous procedures.

It is also contemplated that printed in very large red block letters onboth sides of the fluid reservoir or bag 10 will be warnings posted notto try to increase the rate of flow of fluid into the patient bysqueezing the bag or by any other method whatsoever. It is intended thatthe fluid will flow into the patient under the force of gravity alone,and an approximately 18" vertical height of the fluid reservoir abovethe rectum is desirable to achieve this flow. The prominent warning onthe fluid reservoir should be emphasized at every possible pointthroughout the instructions for the use of the present system inadministering complete col on sweeping of patients and for preventingfecal impaction.

The advantages of the scheduled bowel maintenance techniques describedabove are maximized by employing the apparatus of the invention andcarrying out a complete colon sweeping procedure which will empty theentire colon of its contents. In the preferred method of the invention,the operator, i.e., a nurse, orderly, or other health care professional,will select the correct container 10 as directed by the physician,having a suitable isotonic liquid therein appropriate for the particularpatient. It is alternatively possible that the container will containdry ingredients which are reconstituted into the osmotically balancedisotonic liquid used in the present system by the addition of anappropriate amount of distilled water, typically around 2,000 ml. Thevolume of fluid needed in a particular patient can be measured anddetermined by means of a single contrast barium enema. In cases ofsmaller patients or patients whose colon volume has been reduced bysurgery or disease so that 2,000 ml may be excessive in that particularpatient, then the excess volume of fluid is discarded first, preventingthe infusion of excessive volume of fluid. Each bag would normally besupplied with a tube 11 which is supplemented by line 14 coming from aspring loaded syringe valve 13 which can be used in inflating balloon12. Liquid flow into the tube 11 can be prevented by a suitable clamp24, as observed in FIG. 1.

With reference to FIG. 4, the distal end of the tube 11 would beinserted through the anus 25 of the patient into the rectum 26.Initially, the tube would be inserted far enough to permit the flattenedballoon 12 to completely pass above the anal canal and sphincters. Atthis time, the floppy tip 16 may be folded back and lie against the sideof the tube 11, and the balloon 12 would be deflated so as to lie flatagainst the side of tube 11. Upon initial insertion, it is of coursenecessary to insert the tube 11 far enough for the balloon 12 to clearthe anal opening and anal sphincters. It is therefore possible thatduring said insertion the distal end of tube 11 will engage the wall ofthe rectum. It is also possible that the operators of the apparatus pushthe tube much farther up into the patient than is necessary ordesirable. In either event, the distal end of the tube 11 having floppytip 16 provides a relatively broad soft surface which tends to avoiddamaging the wall of the rectum, and/or would move safety around anyobstruction it might encounter.

After the tube has been inserted, the balloon 12 is inflated fromsyringe valve 13 through line 14 and air passage 20 of dual-channel tube11 to the position as shown in FIG. 5. As illustrated therein, theinflated balloon lies against the floor of the rectum adjacent to theanal opening 25. It takes up very little room in the axial direction,thereby providing a good seal of the anal opening without stimulatingthe rectum to contract and expel the balloon. After balloon 12 has beeninflated and pulled gently down to occlude the lower rectal opening, theliquid is permitted to flow through the tube 11. The pressure head ofthe liquid from the container 10 allows the liquid to flow throughopening 15, as shown by arrow A, and concurrently extends the floppy end16 as shown in FIG. 5.

At the time that the liquid is being infused, the patient is preferablylying on his left side so that the liquid can easily pass into therectum, sigmoid and descending colon. The patient is then rolled ontothe right side down decubitus position so that gravity causes the fluidto flow downwardly through the transverse colon and then into theascending colon and cecum. It is also preferable to impart motion duringthe fluid filling step by any suitable method that will not be harmfulto the patient such as gently rolling the patient from side to side,manipulating the abdomen, etc. The technique for manipulating thepatient to promote the procedure for filling the entire large intestinefrom this point has been described previously in U.S. Pat. No.4,403,982, and reference is made to that description for further detailsof this procedure. By use of the improved method and apparatus of thepresent invention, a complete sweep of the colon is thus possible insafe and effective manner not previously obtainable.

The total system of the present invention as described herein thusprovides a system which not only allows complete removal of the contentsof the entire large bowel in a safe and effective manner which maximizessafety and comfort to the patient, but which can be employed as well tocomprehensively manage and schedule the function of the colon inincontinent patients. The system of the present invention thusrepresents a significant advantage in reducing the time, effort andexpense involved in the care of incontinent patients with variouscolonic disorders, while providing maximum safety and therapeuticbenefits to those patients as well.

Although the invention has been described in considerable detail withrespect to the preferred embodiments, it will be apparent that theinvention is capable of numerous modifications and variations apparentto those skilled in the art, without departing from the spirit, scopeand principles of the present invention.

What is claimed is:
 1. A method of scheduling the function of the bowelso as to minimize or eliminate fecal incontinence, comprising the stepsof:a) inducing constipation in a patient for a multi-day period; b)taking isotonic fluid of sufficient volume to substantially fill theentire large intestine of the patient completely from colon eliminationorifice to the cecum, said isotonic liquid containing a laxative andbeing of a controlled salt and electrolyte composition so as to beisotonic with the patient's body tissues to avoid drawing bodily fluidsinto the large intestine or permitting fluids to pass from the largeintestine into the patient's bloodstream or body tissues; c) insertinginto the patient's colon elimination orifice the distal end of a tube todeliver liquid into the patient; d) delivering the liquid at arelatively slow rate so as to avoid rapid filling and distension of thewalls of the large intestine and taking positive steps to assureretention of the liquid within the colon; e) positioning the patient soas to facilitate the isotonic fluid filling the patient's entire largeintestine; and f) removing the tube and allowing expulsion from thecolon of the isotonic liquid and contents of the large intestine whichhave accumulated during the multi-day period of induced constipation. 2.A method to claim 1, wherein the insertion step includes inserting thedistal end of the tube into the rectum through the anal opening anddelivering the liquid therethrough.
 3. A method according to claim 1,including maintaining the liquid in a container and the inserting stepincludes delivering the liquid from the container through the tube intothe colon elimination orifice.
 4. A method according to claim 1, whereinthe step of assuring retention of the liquid includes inflating aballoon near the distal end of the tube after it is located within thepatient's anal opening.
 5. A method according to claim 1, wherein theinsertion step includes inserting the distal end of the tube into therectum through the anal opening and delivering the liquid therethroughand wherein the step of assuring retention of the liquid includesinflating a balloon near the distal end of the tube after it is insertedwithin the patient's anal opening.
 6. A method according to claim 1,including the step of completely emptying the colon before initiatingthe step of inducing constipation.
 7. A method according to claim 1,wherein the flow rate of the liquid through the tube and into thepatient is maintained no greater than 100 ml per minute.
 8. A methodaccording to claim 1, further comprising the step of imparting motion tothe fluid within the colon by rolling the patient from side to side withthe liquid therein.
 9. An apparatus for facilitating schedulingfunctioning of the bowels so as to minimize or eliminate fecalincontinence, wherein constipation is induced in a patient for amulti-day period, after which isotonic liquid of sufficient volume tosubstantially fill the patient's entire large intestine from colonelimination orifice to cecum, which isotonic liquid contains a laxativeand a controlled salt and electrolyte composition, is introduced throughthe patient's collection elimination orifice, and wherein positive stepsare taken to assure retention of the liquid within the colon after whichthe patient is allowed to expel from the colon the isotonic liquid andthe contents of the colon which have accumulated during the multi-dayperiod of induced constipation, said apparatus comprising:a source ofliquid of a quantity sufficient to substantially fill the patient'scolon from the colon elimination orifice to the cecum, a tube leadingfrom the patient's colon elimination orifice for delivering the liquidtherein, the tube having at least one liquid outlet opening to allow theliquid to pass into the colon and means for assuring retention of thedistal end of the tube of the patient while the liquid is beingintroduced.
 10. An apparatus according to claim 9, wherein the means forretaining includes a balloon near the distal end of the tube, located tobe inflated after the balloon is within the patient's colon eliminationorifice.
 11. An apparatus according to claim 9, wherein the source ofliquid sufficient to substantially fill the patient's colon is acontainer connected to the tube.